Maximizing Revenue in the Chaos of COVID-19. By Lindsey Herman Nolan, MHA, CMPE

Maximizing Revenue

IN THE CHAOS OF COVID-19

By Lindsey Herman Nolan, MHA, CMPE

Maintaining a successful medical practice has always been challenging, but even more so as the healthcare landscape changes daily amid the always changing pandemic. Physician practices continue to fight the same challenges as before the pandemic, now with the added stress and chaos due to COVID-19. Medical practices are facing staffing shortages, increased hostility from patients and the constant pressure of patient needs, all the while trying to maintain profitability.

Because of all of these factors, it is more important than ever for medical practices to focus on maximizing their revenues. Practices cannot afford to absorb lost revenues from ineffective billing or collection processes any longer. With the financial stress of COVID-19, providers should be working to collect every dollar for their services. Below we break down various opportunities to maximize revenues for each visit.

Telehealth: While not a formal part of the billing process, telehealth is an option that is still seeing relatively good reimbursement rates compared with the time and expense required to implement. Telehealth visits allow providers to see and follow up on patients quickly, without added labor expense. Reimbursements, although not as large as they were during the initial pandemic surge, are still higher than they were pre-pandemic. There are also still many telehealth waivers in effect that allow for easy compliance and increased flexibilities with the use of telehealth services. In addition, many technologies, such as EMR systems, now have built-in telehealth capabilities to make scheduling, appointments and documentation easier than ever. Telehealth remains one of the most cost-effective ways to treat patients.

Accurate Demographics: Although billing is typically classified as a back-office responsibility, the process starts as soon as a patient schedules their first appointment with the front office. It is crucial that the front desk ensures that all information is input correctly, especially when the responsible party or subscriber is someone other than the patient. While it sounds tedious, many insurance carriers will take the opportunity to deny claims if there is incorrect information, even if everything else is correct on the claim.

Eligibility Checks: Another front office responsibility is insurance verification and eligibility. It is easy to skip this step to save time, but it is crucial to ensure that the office confirms that patients are actively enrolled in their insurance plans and that they understand the plan details. Unfortunately, many patients enroll in insurance plans from their employer without understanding the nuances, and when it comes time to use insurance, there is a lot of confusion and frustration. Confirming insurance information and educating patients at the time of visit can prevent denials and collection issues from both patients and insurance carriers alike.

Time of Visit Collections: For years, best practice in medical practice management has been collecting at the time of service for patient’s responsibility. This includes everything from co-pays, deductibles, coinsurance and self-pay fees. Offices are significantly more likely to collect revenue if the collection takes place while the patient is captive in the office. In addition to the increased revenues, collecting at the point of service also eliminates the administrative burden of sending invoices, managing collections and potentially having to write off bad debt. It is important to ensure that every practice has a collection policy that includes time of visit collections.

Managing your Revenue Cycle: “What is measured, gets managed” – this phrase, attributed to management icon Peter Drucker, could not be truer in a medical practice’s revenue cycle. With the busy day-to-day operations in medical practices, it is easy to overlook the billing and revenue cycle. However, it is crucial for someone to be tracking key indicators to ensure that billing and collections are being worked appropriately. These indicators include things such as open encounters, days in accounts receivable, accounts receivable aging and denial rates.

Healthcare systems and providers are facing some of the toughest challenges in years, and without ensuring profit for the work being done, many organizations face a grim future. Providers are continuing to treat patients; now we must ensure that they are being appropriately compensated to do so.

Lindsey Herman Nolan, MHA, CMPE is the President/CEO of Nolan Practice Management, a consulting firm based in San Antonio that focuses on the business management of independent, physician owned medical practices. She is also the Secretary of San Antonio Medical Group Management Association. The Bexar County Medical Society is a Silver Sponsor of the San Antonio MGMA.

BCMS Provides COVID-19 Tests to Physicians

The Bexar County Medical Society received a shipment of 8,660 rapid result COVID-19 tests to distribute to physicians and all major medical groups starting in January. The BCMS helped neighboring counties, including Fredericksburg’s Hill Country Memorial Hospital by giving out 1,000 tests.

Vivian Bucay, MD, FAAD receives tests kits from the BCMS. Left to Right: Monica Jones, Betty Fernandez and Danielle Moody sort COVID-19 tests at the Bexar County Medical Society office.

Ana Rodriguez, MD of MacGregor Medical Group unpacks tests kits.